Selective versus routine use of pegfilgrastim in dose-dense chemotherapy.

Abstract

149 Background: ASCO recommends CSFs such as pegfilgrastim for dose dense doxorubicin cyclophosphamide paclitaxel (ddACT) in breast cancer. It is unclear whether dose dense paclitaxel requires pegfilgrastim, and some community oncologists use pegfilgrastim selectively with the dose dense paclitaxel portion of ddACT. We reviewed the results of pegfilgrastim use based on physician preference within a single breast oncology community-based practice. Methods: This is a single-center, single-practice retrospective cohort study of adjuvant ddACT for breast cancer patients identified from the pharmacy database between 1/2010 and 6/2014. Patient demographics, stage, chemotherapy and pegfilgrastim use, chemotherapy delays, febrile neutropenic (FN) events, and pain records including narcotic use were collected from patient charts. Patients receiving pegfilgrastim routinely at cycle 1 were compared to those within the practice given pegfilgrastim selectively for ANC < 1.5 on day of treatment or nadir ANC < 1.0 during the preceding cycle. Differences between groups were analyzed using the Mann-Whitney test, with significance at the p < 0.05 level. Results: The two groups were balanced with regard to age and number of cycles. There were no significant differences in cycle delay, and FN. Routine pegfilgrastim resulted in more bone pain and higher cost. Conclusions: The selective use of pegfilgrastim during the paclitaxel portion of ddACT did not result in chemotherapy delay, more infections or FN. It did decrease painful myalgia and arthralgias, and dramatically lowered treatment cost. These retrospective data, although limited by participant number, question the need for the routine use of pegfilgrastim for the paclitaxel portion of ddACT and require prospective validation. [Table: see text]